Koskinen Kari, Pukkala Eero, Reijula Kari, Karjalainen Antti
Uusimaa Regional Institute of Occupational Health, Helsinki, Finland.
Scand J Work Environ Health. 2003 Feb;29(1):64-70. doi: 10.5271/sjweh.706.
Cancer risk has been estimated for asbestos production workers or other heavily exposed asbestos workers in numerous studies. The bulk of the asbestos epidemic results come, however, from past intermittent exposures during asbestos product use. This study concentrated on estimating the risk of cancer in such a population.
Altogether 23285 men and 930 women invited to a nationwide screening campaign for benign asbestos-related diseases in 1990-1992 were followed for cancer through the Finnish Cancer Register up to 1998. Standardized incidence ratios (SIR) were calculated in comparison with the total Finnish population.
Altogether 1392 cases of cancer were found among the men. The risk was slightly, but significantly elevated for lung cancer [SIR 1.14, 95% confidence interval (95% CI) 1.01-1.26), mesothelioma (SIR 2.77, 95% CI 1.66-4.31), and prostate cancer (SIR 1.21, 95% CI 1.09-1.34). The risk of lung cancer was slightly higher among the invited nonparticipants (SIR 1.48, 95% CI 1.20-1.79) than among the participants (SIR 1.02, 95% CI 0.88-1.17). About 98% of the lung cancers occurred in current or ex-smokers.
In a population of long-term construction workers, the risk of lung cancer and mesothelioma was increased, but considerably lower than among insulators, asbestos sprayers, or patients with asbestosis. As it was not possible to follow most of the invited nonparticipants in the original screening study, selection bias by smoking or other life-style factors possibly correlated to the individual's decision to participate in the health screening cannot be excluded.
在众多研究中，已对石棉生产工人或其他大量接触石棉的工人的癌症风险进行了评估。然而，石棉流行导致的大部分结果源于过去在使用石棉产品期间的间歇性接触。本研究着重于评估这类人群的癌症风险。
1990年至1992年期间，共有23285名男性和930名女性受邀参加全国性的良性石棉相关疾病筛查活动，通过芬兰癌症登记处对他们进行随访直至1998年。与芬兰总人口相比，计算标准化发病比（SIR）。
男性中总共发现了1392例癌症病例。肺癌[SIR 1.14，95%置信区间（95%CI）1.01 - 1.26]、间皮瘤（SIR 2.77，95%CI 1.66 - 4.31）和前列腺癌（SIR 1.21，95%CI 1.09 - 1.34）的风险略有升高，但具有统计学意义。受邀未参与者中肺癌风险（SIR 1.48，95%CI 1.20 - 1.79）略高于参与者（SIR 1.02，95%CI 0.88 - 1.17）。约98%的肺癌发生在当前吸烟者或既往吸烟者中。
在长期建筑工人人群中，肺癌和间皮瘤风险增加，但远低于绝缘工、石棉喷涂工或石棉肺患者。由于在最初的筛查研究中无法对大多数受邀未参与者进行随访，因此不能排除吸烟或其他可能与个人参与健康筛查决定相关的生活方式因素导致的选择偏倚。
